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Aortic valve prosthesis-patient mismatch and exercise capacity in adult patients with congenital heart disease.
- Source :
-
Heart (British Cardiac Society) [Heart] 2016 Jan; Vol. 102 (2), pp. 107-13. Date of Electronic Publication: 2015 Nov 23. - Publication Year :
- 2016
-
Abstract
- Objectives: To report the prevalence of aortic valve prosthesis-patient mismatch (PPM) in an adult population with congenital heart disease (CHD) and its impact on exercise capacity. Adults with congenital heart disease (ACHD) with a history of aortic valve replacement may outgrow their prosthesis later in life. However, the prevalence and clinical consequences of aortic PPM in ACHD are presently unknown.<br />Methods: From the national Dutch Congenital Corvitia (CONCOR) registry, we identified 207 ACHD with an aortic valve prosthesis for this cross-sectional cohort study. Severe PPM was defined as an indexed effective orifice area ≤0.65 cm2/m2 and moderate PPM as an indexed orifice area ≤0.85 cm2/m2 measured using echocardiography. Exercise capacity was reported as percentage of predicted exercise capacity (PPEC).<br />Results: Of the 207 patients, 68% was male, 71% had a mechanical prosthesis and mean age at inclusion was 43.9 years ±11.4. The prevalence of PPM was 42%, comprising 23% severe PPM and 19% moderate PPM. Prevalence of PPM was higher in patients with mechanical prostheses (p<0.001). PPM was associated with poorer exercise capacity (mean PPEC 84% vs. 92%; p=0.048, mean difference =-8.3%, p=0.047). Mean follow-up was 2.6±1.1 years during which New York Heart Association (NYHA) class remained stable in most patients. PPM showed no significant effect on death or hospitalisation during follow-up (p=0.218).<br />Conclusions: In this study we report a high prevalence (42%) of PPM in ACHD with an aortic valve prosthesis and an independent association of PPM with diminished exercise capacity.<br /> (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)
- Subjects :
- Adult
Aortic Valve physiopathology
Aortic Valve surgery
Bicuspid Aortic Valve Disease
Exercise Test methods
Female
Heart Valve Prosthesis Implantation methods
Humans
Male
Middle Aged
Netherlands epidemiology
Postoperative Complications diagnosis
Postoperative Complications epidemiology
Postoperative Complications physiopathology
Prevalence
Treatment Outcome
Exercise Tolerance
Heart Defects, Congenital diagnosis
Heart Defects, Congenital etiology
Heart Defects, Congenital physiopathology
Heart Defects, Congenital surgery
Heart Valve Diseases diagnosis
Heart Valve Diseases etiology
Heart Valve Diseases physiopathology
Heart Valve Diseases surgery
Heart Valve Prosthesis adverse effects
Heart Valve Prosthesis standards
Heart Valve Prosthesis Implantation adverse effects
Prosthesis Failure etiology
Registries
Subjects
Details
- Language :
- English
- ISSN :
- 1468-201X
- Volume :
- 102
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Heart (British Cardiac Society)
- Publication Type :
- Academic Journal
- Accession number :
- 26596791
- Full Text :
- https://doi.org/10.1136/heartjnl-2015-308013